January 02, 2021 4 min read

Female Athlete Triad Syndrome (FATS) is a complex syndrome consisting of three interrelated pathologies.  Understanding Female Athlete Triad Syndrome helps female athletes and the health care professionals taking care of them to prevent long term damage from being done through misdiagnosis or even worse, non-diagnosis.

What is Female Athlete Triad Syndrome?

Female Athlete Triad Syndrome consists of the the following three signs and symptoms:

  • Menstrual Dysfunction
  • Low Energy Availability (with or without eating disorders)
  • Low Bone Mineral Density (that can lead to osteoporosis - the most serious consequence of FATS)

Most female athletes are oblivious to the damage they may do to their bodies if they interfere with their menstrual cycle, even for a short time.  They don’t realize that because their body is not producing the sex hormones it needs, there is damage being done to their bone architecture that can have serious longterm consequences.

Even if disordered eating is not present, the female athlete may not be taking in enough calories to fund the enormous energy requirements of her training and this energy insufficiency may cause enough stress on her body to alter her menstrual cycle, setting the triad in motion. 

If these athletes aren’t aware of the conditions they are at risk of suffering, they may remain undiagnosed and may not receive the treatment required to restore their health, their fertility and enable their sustainable performance and participation in sports.


Who is at risk of developing Female Athlete Triad Syndrome?

As the name suggests, female athletes, even recreational participants in sport, are at  risk of developing Female Athlete Triad Syndrome.  In fact, female athletes are at very high risk to suffer from many conditions which they need to know about in order to be able to prevent long term damage being done to their bodies.

The critical factor behind the development of Female Athlete Triad Syndrome and many other conditions affecting the female athlete is disordered eating or relative energy insufficiency in sport (RED-S).

Female Athletes often face stresses relating to being thin, either slim enough to satisfy coaches or to be able to compete in weight categories that may be too low for their natural size. They often want to be thinner than they naturally are, in order to compete at a higher level. The female body may tend to gain weight around the time of puberty, and it may gain further weight in an attempt to conserve energy when energy demands exceed calorie intake. For female athletes partaking in aesthetic sports (gymnastics, dancing, synchronized swimming, diving etc), there is a massive drive for thinness imposed on them. This often leads to disordered eating.

Are there other conditions associated with Female Athlete Triad Syndrome?

Yes! This drive for thinness, as well as the very high emotional challenges and stress they endure, may put any female athlete, but especially those with Female Athlete Triad Syndrome, at risk for suffering from psychiatric disorders like anxiety, obsessive compulsive disorder, ADHD as well as disordered eating, annorexia nervosa and body dysmorphia, among many others. The earlier these conditions are picked up, the better they respond to treatment and the more likely the teen or adult woman may recover completely.

In addition, ongoing strain, both physically and mentally, may lead to faulty recruitment patterns and pelvic floor dysfunction is often an outcome. The prevalence of pelvic floor dysfunction among female athletes is extremely high and it may lead to: pain, dysfunction, incontinence, sexual dysfunction and injuries further down the kinetic chain. The longer it is left undiagnosed and untreated, the harder it is to rehabilitate this crucial muscle. Without adequate expertise, those taking care of these female athletes may remain unable to restore their pelvic health and this may implicate their performance adversely and add to their stress and contribute significantly to their psychological challenges.

How can Female Athlete Triad Syndrome be prevented?

The prevention of Female Athlete Triad Syndrome is the responsibility of all athletes and all of us who love and care for them.

The female athletic population, both the adolescents and adult women, have special needs, which we all need to be exquisitely aware of. Whether we are an adolescent ourselves, a coach, a parent, or a health care professional, we need to be able to recognize problems that may exist. Some of the special needs female athletes confront are because they live under very high stress and with multiple challenges in the very competitive arena that sport consists of.

Female athletes are at very high risk of suffering from disordered eating, low energy availability or relative energy insufficiency in sport (RED-S) and these all have the potential to cause a cascade of interrelated although seemingly unrelated problems from pelvic floor dysfunction to hypothalamic amenorrhea, osteoporosis and many others.  Health care professionals, coaches, parents and life partners as well as female athletes themselves, need to be able to recognize energy deficiency, and help to work to unravel it, through referral, education, awareness and providing empathetic support as well as through mindful eating and rehabilitation. A change in BMI (body mass index) can be enough to provoke menstrual disturbances. It doesn’t necessarily require extreme thinness, so don’t be misled.

Knowledge is power, awareness is key, and this is a subject many people as well as health care providers know very little about: the female athlete. If you are suffering or think someone you know may be, seek out health from a specialist sports and women’s health practitioner as soon as you can. 

If you would like to read more about the science behind Female Athlete Science Syndrome, follow this link.

Please reach out to one of the MSH team members if you think you might be suffering from Female Athlete Triad Syndrome.  We are here to help you!

Written by Sue Fuller Good

Pelvic Function Physiotherapist, Speaker, Facilitator as well as Energy and Wellness Consultant. 

To book a physiotherpy session with Sue, find her details here.

You can also reach out to join one of her Sexual Health Support Groups.

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